Systematic Review of Studies of Staffing and Quality in Nursing Homes

Bostick, Jane; Rantz, Marilyn; Flesner, Marcia; Riggs, C. Jo

doi:10.1016/j.jamda.2006.01.024

Cited by 316 publications

(251 citation statements)

References 34 publications

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“…Third, the implementation of care quality improvements is often time-intensive for the staff and likely to exceed usual care staffing resources; therefore, consideration of staff time requirements is critical [13][14][15][16][17]. Furthermore, given limited staffing resources, it is important to have clinically defensible criteria to target residents for care delivery [1,2,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have established that higher staffing levels are associated with significantly better care quality and resident outcomes, including feeding assistance care and unintentional weight loss [13][14][15][16]18]. In general, Veterans Affairs (VA) facilities tend to have higher total staffing levels relative to community facilities [19,20].…”

Section: Introductionmentioning

confidence: 99%

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A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Simmons¹,

Durkin²,

Shotwell³

et al. 2013

Behav. Med. Pract. Policy Res.

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Efforts to translate efficacious interventions into longterm care practice have had limited success due to the lack of consideration of key translational intervention components. A multi-faceted intervention was implemented in two veteran affairs facilities to improve feeding assistance care. There were three study phases: baseline, intervention, and follow-up. During each phase, trained research staff conducted standardized observations of 12 meals/participant to assess feeding assistance care quality. The staff received three initial training sessions followed by six consecutive weeks of feedback sessions wherein the observation-based care process measures were shared with the staff. There were significant, but modest, improvements in mealtime feeding assistance care processes, and most of the improvements were maintained during follow-up. A multi-faceted intervention resulted in significant, but modest, improvements in mealtime feeding assistance care quality. Organizational (staff schedules, communication) and environmental (dining location) barriers were identified that interfered with improvement efforts.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Simmons¹,

Durkin²,

Shotwell³

et al. 2013

Behav. Med. Pract. Policy Res.

View full text Add to dashboard Cite

show abstract

“…Increasing staffing levels is one way for nursing homes to maximize spending on labor. Higher total staffing levels (especially greater RN staffing) have been shown to be associated with improved quality of care [123][124].…”

Section: Nursing Home's Investment In Labormentioning

confidence: 99%

“…There is some evidence supporting the potential importance of compensation for recruiting and retaining a stable workforce. With the low wages and benefits, nursing homes find it difficult to compete with fast-food restaurants and other low-wage service sectors and the turnover rates are high [63,126], which are associated with poor quality of care [123,[127][128][129]. Since AB1629 changed payment incentives to encourage and reward nursing homes to invest more in direct care labor, we expect to see nursing homes increasing staffing levels and/or wages.…”

Section: Nursing Home's Investment In Labormentioning

confidence: 99%

“…Prevention of these conditions requires labor intensive care. Pressure ulcers and functional status have proven to be sensitive quality indicators linked to staffing levels due to the considerable amount of nursing staff time necessary to improve outcomes [123]. Pressure ulcers and functional status were selected as outcome quality measures, which develop quickly and over a longer period of time, provided in the nursing home and the decision to hospitalize a resident may involve many factors [138].…”

Section: Outcome Variable: Nursing Home Qualitymentioning

confidence: 99%

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Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Xing¹,

Mukamel²,

Glance³

et al. 2016

WHM

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2013ii Biographical SketchThe author was born in Shanghai, China. She attended Shanghai Second Medical This dissertation provides evidence that linking Medicaid reimbursement rate to each NH's own expenditures and incentivizing NHs to invest in direct care were effective ways in achieving quality improvement. Refinements of current Medi-Cal reimbursement policy might be needed to encourage NHs to make larger investments. However, maximizing NHs' spending on direct care cannot be relied on as the only policy strategy to improve quality of care. vii Contributors and Funding SourcesThis work was supervised by a dissertation committee consisting of Professors

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Finding the Right Level of Posthospital Care

Kane¹

2011

JAMA

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Mr and Mrs B lived in suburban New Jersey, where they had raised 3 daughters. Mr B, aged 79 years, had compensated congestive heart failure, diet-controlled diabetes mellitus, and hearing loss remediated with hearing aids. He was physically, mentally, and socially active. Mrs B, aged 78 years, had chronic back pain that limited her activities; Mr B assisted with laundry and food shopping. Nonetheless, Mrs B was still able to engage fully in an independent and active life.In April 2006 Mr and Mrs B were involved in a severe motor vehicle crash. Mrs B was taken to a hospital, where she was found to have an ankle fracture that required surgery and other minor injuries. Mr B was seen at a different hospital and released to his daughter's home. Three days later, Mr B collapsed; a subdural hematoma was diagnosed and treated surgically, but he remained in a coma in the intensive care unit for more than 5 weeks. Mr B was discharged into an acute rehabilitation facility and thereafter to a skilled nursing facility (SNF). After Mrs B's ankle surgery she received acute rehabilitation and was then discharged to Mr B's SNF. Mrs B's gradual improvement necessitated finding a new place for her to live. Her injuries ruled out stairs, so her multistory house (hours away from her husband and daughter) was not a viable option. Her daughter's home lacked a ground-floor bathroom and also would not work. Mrs B, with input from her daughter, settled on an apartment in congregate senior housing that provided breakfasts and dinners.Mr B was evaluated by the assisted living facility that was affiliated with Mrs B's facility but was turned down be-Many families considering posthospital care options are ill-prepared and in need of guidance. They may not know the range of available options, the relative benefits of each, or have considered their therapeutic goals. Physicians should be informants, advocates, and facilitators of this big leap for their patients. Making a good long-term care decision requires information and structure, but such decisions are often made under great time pressure as part of a hospital discharge. Professional intervention and guidance by an informed but disinterested facilitator may be needed, but hospital discharge planners may not be well suited for this role because their mandate is a rapid discharge. Physicians have 2 crucial roles in these transitions: to ensure the seamless delivery of primary care and to advocate for and facilitate, however possible, better decision making. Physicians need at least a rudimentary knowledge of the array of options and the implications of each. Even if the physician cannot serve as the planning facilitator, the physician should ensure that this task is done well. This review describes the range of options and the implications of each option for long-term care in the United States. It suggests the need for evaluating each patient's care goals, family circumstances and resources, and clinical status to determine if more aggressive medical care might improve an individual's clini...

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Systematic Review of Studies of Staffing and Quality in Nursing Homes

Cited by 316 publications

References 34 publications

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Finding the Right Level of Posthospital Care

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